Cutaneuos cryoglobulinemic vasculitis induced by chronic hepatitis C virus infection

As vasculites cutâneas podem representar grande desafio clínico, mesmo após exame dermatológico cuidadoso e realização de exames complementares. Os autores apresentam caso de vasculite crioglobulinêmica cutânea associada à infecção crônica pelo vírus da hepatite C, salientando a importância do exame dermatológico na investigação diagnóstica. Discutem ainda a importância da busca da etiologia e da correta classificação no prognóstico e terapêutica das vasculites cutâneas.Cutaneous vasculitis may represent a great clinical challenge, even after careful dermatological examination and laboratory assessment. The authors present a case of cutaneous cryoglobulinemic vasculitis associated to chronic hepatitis C virus infection, pointing out the importance of the dermatological examination for diagnostic investigation. They discuss about the importance of defining the etiology and making correct classification for appropriate prognosis and treatment of cutaneous vasculitis

Association between ear creases and peripheral arterial disease

INTRODUCTION: Peripheral arterial disease is a severe manifestation of atherosclerosis that can lead to critical ischemia of the lower limbs and is also associated with high cardiovascular risk. Diagonal lobular and anterior tragal ear creases have been associated with coronary artery disease, but they have not yet been investigated in patients with peripheral arterial disease. OBJECTIVES: To evaluate the prevalence of ear creases among patients with peripheral arterial disease of the lower limbs, compared with patients without documented atherosclerotic disease. METHODS: Cross-sectional study including 60 male patients with peripheral arterial disease of the lower limbs and 60 dermatologic outpatients matched for age and gender. The associations were adjusted for other risk factors by conditional logistic regression. RESULTS: The prevalence of diagonal and anterior tragal ear creases was higher among cases (73% vs. 25% and 80% vs. 43%, respectively) than controls; these associations remained significant even when adjusting for other known risk factors of atherosclerosis (odds ratio = 8.1 and 4.1, respectively). CONCLUSIONS: Ear creases are independently associated with peripheral arterial disease and may be an external marker for risk identification

Translation, cultural adaptation and validation of the Somatic Symptom Scale-8 (SSS-8) for the Brazilian Portuguese language

BACKGROUND: Assessment tools are commonly used in different fields of health to assist in the diagnosis, the evaluation of the response to treatment, the measurement of quality of life and the establishment of the prognosis. OBJECTIVES: Translate, culturally adapt and perform the psychometric validation of the Somatic Symptom Scale (SSS-8) for use in the Brazilian population. METHODS: Cross-cultural adaptation followed a combination of guidelines and for psychometric evaluation a sample of 300 patients was recruited. All recommended measurement properties by the Consensus-based Standards for the selection of health status Measurement Instruments were evaluated, including analysis by an expert committee and analysis by the target public. The Skindex-16 was used for the evaluation of convergent validity and Cronbach's alpha was used for the determination of the internal consistency of the translated version of the SSS-8. RESULTS: The final version received approval from five experts and the agreement index was 100% for all items. During the pretest, the scale was administered to 300 patients with psoriasis and none of the items needed to be altered. A moderate correlation was found between the Skindex-16 and SSS-8-BRA. In the analysis of internal consistency, Cronbach's alpha for the SSS-8-BRA was 0.81. CONCLUSION: The SSS-8 is a valid and reliable tool for the assessment of somatic symptoms in the Brazilian population

The EU and US : friends or rivals

As boas relações entre a União Europeia e os EUA são essenciais para a estabilidade global. Mas as actuais relações transatlânticas permanecem constrangidas sobretudo como resultado da guerra no Iraque e da abordagem unilateral da primeira administração George W. Bush. As divergências entre UE-EUA têm aumentado nas áreas políticas e estratégicas bem como nas áreas económicas e sociais. Uma das maiores divergências incide sobre a governação global e sobre o papel atribuído à ONU e a outras instituições multilaterais. Também existe um elevado grau de anti-americanismo (ou de oposição às políticas da administração Bush) na Europa, e de ressentimento para com a Europa (ou melhor, para com a França e Alemanha) nos EUA. A UE não tem ideia de como lidar com a única superpotência mundial. Normalmente prefere- se o bilateral aos canais europeus. Mas as actuais estruturas UE-EUA não permitem uma discussão séria sobre muitas destas diferenças. Nem a OTAN é uma estrutura adequada para um diálogo estratégico transatlântico, como o chanceler Schroeder referiu na Conferencia Wehrkunde, em Munique, em Janeiro de 2005

Dermatúnel: a model of interactive learning environment in dermatology

O Ambiente Interativo de Aprendizagem (AIA) é um modelo educacional que integra recursos de computação gráfica 3D e contextualização, com objetivo de transmitir um conjunto de conhecimentos (ilhas de conhecimento), de forma precisa e ágil, para pessoas que não conhecem o assunto. Utiliza recursos de multimídia apoiados em ambientação contextualizada para motivar os participantes na retenção de conhecimento. Na primeira versão, foram abordados oito assuntos relevantes de dermatologia. O modelo foi implementado no 62º Congresso Brasileiro de Dermatologia e denominado Dermatúnel. Participaram das visitas 3295 pessoas, num período de quatro dias. Os resultados demonstraram alta satisfação dos participantes. Possui grande potencial como ferramenta educacional para formação médica e orientação do público geral para fins de prevenção de doenças.The Interactive Learning Environment (ILE) is an educational model that integrates features of 3D computer graphics and contextualization, in order to transmit a quantum of knowledge (islands of knowledge), in a precise and agile way, to people who do not know the subject. It is a model that uses multimedia resources supported by a contextualized environment to motivate the participants in the retention of knowledge. In this first release, eight relevant subjects in dermatology were addressed and implemented in the 62nd Brazilian Congress of Dermatology. The model was called Dermatúnel. In a period of four days, 3295 people visited it. The results showed that the participants were highly satisfied. The model has a great potential as an educational tool for medical training and guidance to the general public with the purpose of disease prevention

Percepção de dermatologistas sobre a influência da psoríase na qualidade de vida dos pacientes

Objective: to know how psoriasis affects the quality of life of patients in the perception of dermatologists and identify strategies for improving it and reorganizing care. Methods: Descriptive, exploratory study research conducted in a public hospital in the countryside of São Paulo, from December 2017 to March 2018, with six dermatologists. The interviews were transcribed and analyzed using the methodological strategy of the Collective Subject Discourse. Results: Psoriasis is a disease, which affects the quality of life because it is associated with psychosocial disorders, shame, stigma and loss of self-esteem. Reducing injuries and symptoms, improving appearance, having an effective medication coupled with humanized care are fundamental for improving the quality of life of these patients. Conclusion: It was observed that for dermatologists, psoriasis is a chronic disease that interferes with the quality of life, due to the prejudice felt by patients, the psychosocial disorders and negative feelings that arise, as well as the social difficulties faced, by them.Objetivos: conocer cómo la psoriasis afecta la calidad de vida de los pacientes en la percepción de los dermatólogos e identificar estrategias para mejorarla y reorganizar la atención. Métodos: Investigación descriptiva y exploratoria realizada en un hospital público del interior de São Paulo, de diciembre de 2017 a marzo de 2018, con seis dermatólogos. Las entrevistas fueron transcritas y analizadas utilizando la estrategia metodológica del Discurso Colectivo del Sujeto. Resultados: En opinión de los participantes, la psoriasis es una enfermedad que daña la calidad de vida por estar asociada a trastornos psicosociales, estigma, vergüenza y pérdida de la autoestima. Reducir lesiones y síntomas, mejorar la apariencia, disponer de una medicación eficaz vinculada a la atención humanizada son fundamentales para mejorar la calidad de vida de estos pacientes. Conclusión: Se observó que, para los dermatólogos, la psoriasis es una enfermedad crónica que interfiere con la calidad de vida, debido al prejuicio sentido, los trastornos psicosociales y sentimientos negativos que surgen, así como las dificultades sociales que enfrentan los pacientes.Objetivo: Conhecer como a psoríase interfere na qualidade de vida dos pacientes na percepção de dermatologistas e identificar estratégias para melhoria e reorganização da assistência. Métodos: Pesquisa exploratória e descritiva, realizada em hospital público do interior de São Paulo, no período de dezembro de 2017 a março de 2018, com seis dermatologistas. As entrevistas foram transcritas e analisadas utilizando-se a estratégia metodológica do Discurso do Sujeito Coletivo. Resultados: Psoríase é uma doença que inflige prejuízo à qualidade de vida por estar associada a transtornos psicossociais, estigma, vergonha e perda da autoestima. Reduzir lesões e sintomas, melhorar a aparência, disponibilizar medicamento eficaz e oferecer atendimento humanizado são aspectos fundamentais para melhoria da qualidade de vida destes pacientes. Conclusão: Para os profissionais dermatologistas, a psoríase é uma doença crônica, que interfere na qualidade de vida dos pacientes, em virtude do preconceito sentido, dos transtornos psicossociais e sentimentos negativos que afloram, bem como das dificuldades sociais enfrentadas

Cryosurgery with liquid nitrogen versus trichloroacetic acid in the treatment of human papillomavirus (HPV) penile wart: a randomized controlled trial

Background: Anogenital warts are the most prevalent sexually transmitted infection (0.5%) among dermatological consultations. Cryotherapy with liquid nitrogen (LN) and therapy with trichloroacetic acid (TCA) are remarkable among the treatment strategies. Objective: To evaluate the effectiveness of LN versus TCA in to treat penile warts in patients from a Brazilian public institution. Methods: Open, parallel, randomized clinical trial. Following randomization, the warts were counted and submitted to cryotherapy (10s) or case therapy (TCA 80%) in each visit. The primary dependent variable was the lesion count before and after four weeks of treatment. We assessed the following variables: complete clearance, age, immunosuppression, smoking, topography, and education. Results: 142 treatments were evaluated in 52 participants. There was a predominance of young adults, and the main topography affected was the penis shaft. The mean reduction rate per session was 48% for LN and 26% forTCA (p=0.11). 42 (81%) participants achieved complete clearance, with 39 (75%; 95% CI: 64-85%) reaching clearance in up to three sessions. Age was associated with a worse therapeutic response rate (β =-0.09; p<0.01). Conclusions: LN and TCA proved to be effective to treat penile warts, without difference between treatments. Age was associated with a worse therapeutic response

Dermatúnel: modelo de ambiente interativo de aprendizagem em dermatologia

The Interactive Learning Environment (ILE) is an educational model that integrates features of 3D computer graphics and contextualization, in order to transmit a quantum of knowledge (islands of knowledge), in a precise and agile way, to people who do not know the subject. It is a model that uses multimedia resources supported by a contextualized environment to motivate the participants in the retention of knowledge. In this first release, eight relevant subjects in dermatology were addressed and implemented in the 62nd Brazilian Congress of Dermatology. The model was called Dermatúnel. In a period of four days, 3295 people visited it. The results showed that the participants were highly satisfied. The model has a great potential as an educational tool for medical training and guidance to the general public with the purpose of disease prevention.O Ambiente Interativo de Aprendizagem (AIA) é um modelo educacional que integra recursos de computação gráfica 3D e contextualização, com objetivo de transmitir um conjunto de conhecimentos (ilhas de conhecimento), de forma precisa e ágil, para pessoas que não conhecem o assunto. Utiliza recursos de multimídia apoiados em ambientação contextualizada para motivar os participantes na retenção de conhecimento. Na primeira versão, foram abordados oito assuntos relevantes de dermatologia. O modelo foi implementado no 62º Congresso Brasileiro de Dermatologia e denominado Dermatúnel. Participaram das visitas 3295 pessoas, num período de quatro dias. Os resultados demonstraram alta satisfação dos participantes. Possui grande potencial como ferramenta educacional para formação médica e orientação do público geral para fins de prevenção de doenças

Development and validation of an artificial neural network to support the diagnosis of melanoma from dermoscopic images

Introduction: With the advancement of digital image analysis, predictive analysis, and machine learning methods, studies have emerged regarding the use of artificial intelligence in imaging tests such as dermoscopy. Objective: Construction, testing, and implementation of an artificial neural network based on characteristics of dermoscopic images. Methods: 1949 images of melanocytic nevi and melanomas were included, both from the authors’ files and from dermoscopic image banks available on the internet, and routines and plugins were developed to extract 58 features applied to a multilayered neural network construction algorithm. Also, 52 dermatologists assessed 40 random images and compared the results compared. Results: The training and testing of the neural network obtained a correct percentage of classification of 78.5% and 79.1%, respectively, with a ROC curve covering 86.5% of the area. The sensitivity and specificity of dermatologists were 71.8% and 52%. For the same images and a cutoff point of 0.4 (40%) of the output value, the application obtained 62% and 56% values, respectively. Conclusions: Multilayer neural network models can assist in the dermoscopic evaluation of melanocytic nevi and melanomas regarding the differential diagnosis between them